Provider Demographics
NPI:1518001759
Name:LARRY CRAIG SEMER
Entity type:Organization
Organization Name:LARRY CRAIG SEMER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:SEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-458-3668
Mailing Address - Street 1:223 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE A.
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5542
Mailing Address - Country:US
Mailing Address - Phone:954-458-3668
Mailing Address - Fax:954-458-3109
Practice Address - Street 1:223 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE A.
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5542
Practice Address - Country:US
Practice Address - Phone:954-458-3668
Practice Address - Fax:954-458-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1007213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4921310002Medicare NSC
FLK2960Medicare PIN
FLT85773Medicare UPIN